Monday, September 26, 2011

NEW DISEASE ATTACKING FEMALE CHILDREN IN CANADA

First diagnosed in Canada in 2007 anti-N-methyl-D-aspartate receptor encephalitis has affected 22 young female victims. Some of the cases were profiled on the CTV News last night and there is an article on their web page. The symptoms are frightening and bizarre thus early recognition and treatment is of the utmost urgency. The more the public and medical personnel become aware of this new disease the earlier it will can be recognized and the sooner intervention and treatment can begin.

Anti-N-methyl-D-aspartate receptor (anti-NMDA-R) encephalitis is an immune-mediated syndrome that remains under-recognized despite a growing body of literature. This syndrome has been predominantly described in young females with a constellation of symptoms, including personality changes, autonomic dysfunction and neurologic decompensation. It is commonly associated with mature ovarian teratomas. We describe the classic presentation of anti-NMDA-R encephalitis in three dramatically different patients: Case A, a young woman with ovarian teratoma; Case B, the eldest case reported to date; and Case C, a young male with no identifiable tumor. We review the literature summarizing the differential diagnosis, investigative approach, treatment options and challenges inherent to this disorder. We advocate good supportive care, involvement of multiple health disciplines and use of immune-modulating therapies in patient management. These cases underscore the need for increased awareness and high diagnostic suspicion when approaching the patient with suspected viral encephalitis.